PB2089: ALGORITHM FOR SEVERE COVID-19 RISK STRATIFICATION DEPENDING MONOCLONAL ANTI-CD20 ANTIBODIES TREATMENT DURATION IN NON-HODGKIN LYMPHOMA PATIENTS.
Authors: K. Sychevskaya, S. Kravchenko, F. Babaeva, A. Misyurina, A. Korneeva, A. Abdulpatahov, R. Abdurashidova, A. Keniaykina, Z. Sarakaeva, E. Fastova, L. Gorenkova, E. Nesterova, Y. Mangasarova, M. Bagova, O. Margolin, A. Magomedova
Journal: HemaSphere (2022)

Background: Optimization of Non-Hodgkin’s lymphomas (NHL) treatment during the COVID-19 pandemic is urgently needed. Monoclonal anti-CD20 antibody (MA) treatment has been recently defined as an independent factor of unfavorable prognosis of COVID-19. The negative role of MA treatment during COVID-19 is related to combined B-cell and T-cell depletion after MA administration. This is especially critical for those lymphomas that require long-term MA maintenance therapy (MT). However, we believe not only the fact of MA administration but mostly prolonged MA therapy is associated with severe COVID-19 course. If true the safety and rationality of prolonged MA treatment and, in particular, MT in NHL patients during the ongoing COVID-19 pandemic should be revised. Aims: To analyze association between COVID-19 course and the fact of MA treatment and duration and time points of initiation and completion of MA therapy as well in NHL patients. Methods: From April 2020 to February 2022 a total of 83 NHL patients with COVID-19 were observed. Informed consent was obtained from all patients. Statistical analysis was performed in STATISTICA 12.0 software (TIBCO Software, Inc., USA). Results: As was shown before combined immunodeficiency is formed after 6 months, on average, after MA therapy initiation. Additionally restoration of humoral and cellular immunity occurs, on average, 6 months after the end of MA therapy. Therefore, we supposed more than a 6-month duration of MA treatment and less than a 6-month interval from the last MA injection to COVID-19 are critical features for a severe COVID-19 course. The algorithm considering both of these characteristic was proposed (Figure A). As our NHL cohort was heterogeneous, there were patients after chemotherapy without MA inclusion at all (a total of 13 cases, mostly T-cell lymphomas patients). This group initially was analyzed separately (Figure B). We identified that 2-year OS after COVID-19 manifestation is significantly decreased in “high-risk” MA patients (p=0.02, Log-rank test), exactly, 52% vs 76% in “low-risk” MA group. OS in “no MA” group was mostly similar to that in “low-risk” MA group, so these cohorts were merged (Figure C). Two-year OS in these combined group was 74%, that remained to significantly exceed OS in “high-risk” MA patients (p=0.03, Log-rank test). Image:Summary/Conclusion: As we initially supposed, our results established both the duration of previous MA therapy and the time before the manifestation of COVID-19 are important for following COVID-19 infection course in NHL patients. Prognosis of patients after chemotherapy without MA administration is comparable with those patients who had MA treatment of less than 6 months duration or had shortly begun MA treatment before COVID-19. However, this fact needs to be refined as groups were not comparable in terms of lymphomas type. Additionally we were not able to evaluate different chemotherapy regimens influence on COVID-19 course, as cohort was extremely heterogeneous. Nevertheless we believe our results prove prolonged MA in NHL patients is not safe and excluding MA from MT is rational during the ongoing COVID-19 pandemic.